IHS IEE Representation Form_Jan 2022_508 Compliant.pdf
PDF 1 MB Posted
- Attached to
- SOURCES SOUGHT NOTICE: Relocation of Trailers
- Solicitation number
- IHS1507337
About this file
This is an Indian Economic Enterprise (IEE) Representation Form from the Indian Health Service (IHS) Office of Management Services, accompanied by a Sources Sought Notice for the relocation of two single-wide mobile office units at the Inscription House Health Center in Shonto, AZ. The form requires self-certification that offerors meet the definition of an "Indian Economic Enterprise" under the Buy Indian Act, with 51% Indian ownership maintained throughout the solicitation, award, and contract performance periods.
The Sources Sought Notice (tracking number IHS1507337) seeks capability information from potential contractors under NAICS code 321991 with a size standard of 1,250 employees. Responses are due by February 9, 2025, 5:00PM MST. Interested parties must submit their IEE status, experience with similar work from the past five years, UEI number, and intention to bid as prime contractor. The period of performance is from award date through July 31, 2025. The acquisition strategy will be determined based on responses, with preference given to Indian economic enterprises under the Buy Indian Act. The primary point of contact is Flora Washington, and work will be performed at the Inscription House Health Center in Shonto, AZ.
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| 2025 -SOW - IHHC Mobile Office Units Placement .pdf |
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Text version
DEPARTMENT OF HEALTH & HUMAN SERVICES
Indian Health Service
Office of Management Services Division of Acquisition Policy (DAP)
5600 Fishers Lane Rockville, MD 20857
INDIAN HEALTH SERVICE
BUY INDIAN ACT
INDIAN ECONOMIC ENTERPRISE
REPRESENTATION FORM
SOLICITATION/SOURCES SOUGHT/RFI #: _________________________________________________
PROJECT TITLE: ________________________________________________________
DATE: ___________________________________________________________________
In accordance with 25 U.S.C. 47 the Buy Indian Act, the signature below constitutes self-certification that the Offeror meets the definition of an “Indian Economic Enterprise” (HHSAR 326.601) in response to this Sources Sought Notice, Request for Information (RFI) or Solicitation and resultant contract.
The enterprise must meet the definition of “Indian Economic Enterprise” throughout the following time periods:
(1) At the time an offer is made in response to this solicitation;
(2) At the time of contract award; and
(3) During the full term of the contract performance period. At any point during these periods, if the Contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting Officer.
Individual Contracting Officers may require documentation of eligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with the System of Award Management (SAM).
Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under 18 U.S.C. 1001.
False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C. 3729 to 3731 and 18 U.S.C. 287.
REPRESENTATION
The Offeror represents as part of its offer that it does _____, does not _____ meet the definition of an “Indian Economic Enterprise” with “Indian Ownership” under the authority of the Buy Indian Act.
Name of the 51% owner of IEE Firm
Certifying Signature
Print Name
Name of Federally Recognized Tribal Entity
Business Name
DUNS Number
| DATE: |
| DUNSnumber: |
| BusinessName: |
| NameOfTribalEntity: |
| OwnerName: |
| PrintName: |
| SOLICITATION_NUMBER: |
| PROJECT_TITLE: |
| DoesNot: 0 |
| Does: Off |
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